Category: Body Image

Therapy and counseling for weight management.

Looking back over the course of my 40 something years, I have learned a few things. One of the things I wish I had done sooner was seek counseling or therapy for my obesity and weight management. I started dieting when I was 12 years old and I cannot remember a time when I was not on a diet.

In my 20’s I remember looking at pictures of myself at age 12 and realizing I was not really that overweight. I can remember being teased about my weight since the second grade. My mother, God Bless her, sewed me a dress made from brown corduroy and it had a matching bunny in the pocket. The first day I wore it to school, I was called names on the playground. I think it was less about the outfit, but being the young age I was somehow thought the outfit made it worse.

The benefit for some in getting therapy is to discuss any situations or trauma that might have impacted a persons weight. It might help determine what is a genetic component vs behavioral and when to seek additional treatment. One of the first questions my psychologist asked me was if I thought a trauma or event triggered my overeating at a young age. She said it was important that this be addressed in order to move forward. I was surprised when I burst into tears during a session with my psychologist.

Here is a link to the American Psychological Association about benefits of counseling and therapy for weight management. https://www.apa.org/helpcenter/weight-control

This is a subject I could write on all day. I would recommend if this is something you might benefit from to do some further research. I wrote a paper in college on one form of therapy called cognitive behavioral therapy. I went to the John Hopkins website and found an article that discusses the benefits of this type of therapy for weight management. Here is the link: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/intensive-behavioral-therapy-for-obesity

Do some research, talk to a counselor or a clinician to find out if this is something you might benefit from. I chose the John Hopkins link because they have been around many years and have a good reputation. The company I work for partnered with John Hopkins on a project to address obesity and I participated in the project. My BMI qualified me and so I signed up. This involved lifestyle changes through exercise and calorie reduction with a focus on higher protein diets and less fat. I received access to a lifestyle coach I spoke to on the phone. I lost over 24 pounds and kept it off for a while.

As you all know I’ve shared that over the years I was able to control my weight off and on. After my early 40’s though I felt like my diabetes, PCOS, and some other conditions were out of control and losing weight through dieting alone was not working for me. I therefore reached out to explore bariatric surgery. In that process I do have access to a psychologist and have found the sessions to be very helpful in recognizing patterns.

It’s also important to remember that even with therapy, counseling, or cognitive behavioral therapy, obesity can really be a genetic condition that you have little control over. One of the things I’ve treasured the most about my bariatric surgery team is when they told me my hormones were out of control and that my weight was not all my fault. I felt like a successful person in so many ways and then a real failure when it came to my weight. I do highly believe in therapy for many reasons and to help manage weight at the same time as I do recognize that therapy may just be a starting point. Cognitive behavioral therapy might not be for everyone, so finding the right counselor or therapist to point you in the right direction is important. It might help you sort out what your priorities are or suggestions to try something new or different.

Another suggestion is to check in with your primary care provider to see if they have a counselor or therapist recommendation. Some dietitians also offer types of food related counseling and might have some further recommendations for you.

The reason I wished I had done it sooner was perhaps it would have helped me create a more positive body image and then help me create new behaviors to control my weight. At this time in my life, I used it to prepare myself for my new journey and stay on that path. As people we need to feel okay and give ourselves permission to seek additional guidance and counseling. Remember this is written from my opinion, my personal journey, and from those I know in my personal life. It is always best to check in with your clinician to find out what is right for you. Well wishes to all of you on your life path and journey.

Mandy

Weight Bias in Healthcare

Weight bias in healthcare is a subject near and dear to my heart. Having been overweight since I was five years old, I have experienced this a time or two. The reason this is important to me is so other people know how to advocate for themselves in order to get to a problem that may or may not be weight related. I am realistic and aware that weight does increase some health problems. This is the very reason I went through Bariatric Surgery so I could lose weight and my weight related problems. That said not all health problems are weight related. I also do not want the type of person I am judged based on my number on a scale or how I look.

My definition of weight bias is when a clinician cannot see past the patient’s weight or makes assumptions about the person based on weight. This patient must not exercise, eat healthy, or even try to get motivated. I had a clinician who told me once that he did not care what I had to do to lose weight, I should just do it. When I expressed how hard weight loss is for me, he told me that if I were on a deserted Island, I would probably lose weight. Weight bias is when a clinician is not able to perform motivational interviewing to get to the heart of a health issue and leap right to conclusions about this patient and their weight problem.

I read an article by Leigh Richards, a nursing student sharing her own story of weight bias. She had an appointment for a health issue when the physician who really did not know her suggested weight loss surgery. She did so without asking any questions or even getting to know the patient.  You can find the article through this link. https://blogs.ohsu.edu/studentspeak/2019/04/26/weight-bias-in-healthcare-an-opportunity-for-action/ What I liked about her article was sharing her tips for fighting weight bias. Her personal experience is that she declines to be weighed unless it is medically necessary. When advised to lose weight she says she asks the clinician what the advice would be for the condition if this were a thin person. She finds clinicians who find value in her as a whole person and she makes her wishes known, advocating for herself.  This really resonated with me and I thought it was good advice.

Once I declined to be weighed at my physician’s office and the medical office staff told me I couldn’t refuse. She was so baffled about my refusal and then instantly became indifferent and cold to me. Never mind that the scale is in the middle of the hallway and it seems every time they called out my weight for all to hear. I would often avoid the medical community because I did not want another lecture or the whole focus of the visit to be on my weight. That can be dangerous.

Another article I read reminded me weight bias is more than just what we have mentioned already. It’s also when a clinic or hospital setting is ill equipped to care for overweight patients. They used the example of having gowns that do not fit, exam tables that are too small, equipment that is not big enough or fit right, and discriminating based on weight. This article can be found here: https://journalofethics.ama-assn.org/article/weight-bias-health-care/2010-04

One example I have of this is when I was pregnant with my son and every time, I went to the doctor my blood pressure was really high. The nurse though always used the wrong BP cuff for my size which gives false results. The doctor wanted to prescribe more medication based on this result and I declined. I did take my BP at home and have my co-workers check for me. Those readings were normal. In the end I did end up with severe high blood pressure and pre-eclampsia. I felt though my specialist treated me like my weight was the problem. He told me to lose weight if I wanted another child. Later after doing my research I was shocked to learn how many thin women have pre-eclampsia because I was made to feel it was weight related.

My own personal advice is to advocate for yourself. If you are comfortable with yourself and do not wish to lose weight, speak up. If you do wish to lose weight or change something, that is okay too. The bottom line though is to ask those questions to get the clinician past the weight bias. Being in healthcare I am aware that a lot of attention is on this subject right now. We are realizing as a healthcare team that shaming or blaming an overweight person is not helpful to their holistic care. Find a clinician or healthcare provider that helps you get to your healthcare goals no matter what they are. Advocate they use appropriate equipment.

It was so nice going to my bariatric surgeon’s office. This was one place I was told that my weight is not all of my fault and I was treated with dignity and respect, never shamed. I do realize I was asking for weight loss help, but this team truly knows how to take care of overweight patients without bias. All of the equipment and spaces were designed for overweight patients.

I hope you found this information helpful. If you feel comfortable, feel free to leave a comment about your own experience. My goal in writing this is to help people understand weight bias and not to avoid clinicians or critical check ups because of fear of blame or shame.

Even though this article is about weight bias, I still must say that you should always seek healthcare advise to find out what options are right for you. Once you feel comfortable with your clinician though, you can truly make an informed decision about your own health.

Best of wishes,

Mandy

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